Most Prostate Cancer Treatment Doesn’t Save Lives

A 10-year outcome study just published in the prestigious New England Journal of Medicine shows that men diagnosed with prostate cancer who chose to forgo treatment were no more likely to die. Surgery and radiation therapy often have severe side effects such as incontinence and impotence.

I have recently been seeing promotions on social media for Blue September New Zealand that suggest I should get screened:

We’ve all got fears. But a prostate check shouldn’t be one of them. Each year prostate cancer kills 600 Kiwi men – now that’s scary. So this Blue September, we want you to face your fear for prostate cancer awareness month.

The prostate-specific antigen test for prostate cancer was developed in the 1990s, quickly followed by an explosion of PSA screening for the disease and a further explosion of treatment. Treatment consists of either radiation or surgical removal of the prostate. The treatments have hard-to-live-with side effects such as urinary and bowel incontinence and loss of sexual function.

Yet the disease itself is often not particularly life-threatening. It’s a truism that most men diagnosed with prostate cancer will die of something else first. Experts grew alarmed at the rush to treatment, much of which was likely to injure patients without extending their lives. They began arguing against routine PSA screening, especially mass screening.

Now there is strong evidence that watchful waiting is a reasonable approach for most men with prostate cancer. British scientists studied more than 1600 men for 10 years. The men had been randomized into groups that had surgery or radiation or underwent only “active monitoring.” Most of the men survived no matter which group they belonged to.

4 Responses to “Most Prostate Cancer Treatment Doesn’t Save Lives”

It may be that men with more severe symptoms will improve their chances of survival through treatment. Also, men perhaps have the right to know whether they have prostate cancer or not and to make an informed choice about treatment.

There is a case to be made that men deserve some subsidization of testing if they experience certain symptoms, given what is spent on free breast and cervical screening for women. Alternatively or additionally, gender equality may also be served by an announcement of substantial funding for research into ways that men might avoid or better manage prostate cancer, and dissemination of what is learned through that research. I understand that more men die from prostate cancer (as opposed to with it) than women die from breast and cervical cancer combined.

These “studies” really piss me off. They fail to ask one very important question of the men who have had their prostate removed surgically ….. “We’ve done a study and concluded that your cancerous prostate might not kill you. Would you like us to implant it back in your body ?”

First. I saw an article a while ago, that suggested that men having more sexual partners in their lifetime, was increasing prostate cancer rates.

Second. In conversation recently I heard the opinion that older men engaging with a new partner are likely to see a spike in psa readings, caused by either renewed sexual activity or minor urinary tract infections.

What is the current medical thinking around this?

There are a couple of other questions that have come up in recent conversations.

A man who had his prostate removed says he has a rising psa that is being monitored?

Does this mean his prostate cancer had spread before his prostate was removed, or does the psa reading indicate a range of possibilities including prostate cancer.

A man who had prostrate radium treatment in the past had an increased psa reading which on investigation found that the cancer had relocated to the area of his back surgery.

I’m guessing back surgeons wouldn’t want that news spreading, although I understand there is also a move away from surgical options to less invasive forms of treatment where possible for men’s back injuries, which have probably taken a similar unnecessary routine treatment regime?

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